Probiotics Combined with Laxatives found Effective for Treating Pediatric Functional Constipation

A network meta-analysis found a combination of probiotics and laxative effective at treating pediatric functional constipation. 
Pediatric constipation affects 0.7% to 29.6% of children globally, with functional constipation accounting for 95% of cases. Despite its prevalence, pharmacological treatments have limited efficacy, with a 60% success rate. Probiotic supplements have shown potential benefits in randomized controlled trials (RCTs), though the probiotic strains used varied significantly across studies. 
This network meta-analysis (NMA) aimed to evaluate the efficacy and acceptability of various probiotic supplements in managing pediatric functional constipation. The analysis included nine RCTs with 710 participants (mean age: 5.5 years; 49.4% girls), assessing the impact of probiotics, alone or with laxatives, on bowel movement frequency and treatment acceptability.
Results demonstrated that most probiotics, whether used individually or with laxatives, significantly improved bowel movement and stool frequency compared to placebo/control. Protexin combined with laxatives showed the greatest improvement (SMD = 1.87, 95% CI: 0.85 to 2.90), outperforming all other products. Among single probiotic treatments, only Lactobacillus casei rhamnosus Lcr35 achieved significant efficacy compared to placebo/control (SMD = 1.37, 95% CI: 0.32 to 2.43). All probiotic products had similar rates of fecal incontinence and dropouts as the control groups. 
This NMA supports the use of combined probiotics and laxatives for pediatric functional constipation, provided no contraindications exist, and highlights the importance of specific probiotic strains in treatment efficacy.